William R. Jarvis, M.D.

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Bloodstream infections with vancomycin-resistant enterococci

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Abstract

OBJECTIVES: To describe the population in whom bloodstream infections with vancomycin-resistant enterococci occur and the clinical and microbiologic features of infection.

METHODS: From June 1, 1991, to January 31, 1994, 73 patients with bloodstream infections with vancomycin-resistant enterococci were identified by retrospective review of hospital charts and microbiology records.… Read more

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Risk factors for ventilator-associated pneumonia in surgical intensive-care-unit patients

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Abstract

Patients admitted during the study period to the Sharp Memorial Hospital intensive-care units who required mechanical ventilation were followed prospectively; 15 (10.4%) of 145 acquired ventilator-associated pneumonia (VAP). Duration of prior oral or nasal intubation and H2 receptor antagonists use were longer among patients who developed VAP than among those who did not.… Read more

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Gram-negative bacteremia in open-heart-surgery patients traced to probable tap-water contamination of pressure-monitoring equipment

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Abstract

OBJECTIVE: To determine the cause(s) of an outbreak of gram-negative bacteremia (GNB) in open-heart-surgery (OHS) patients at hospital A.

DESIGN: Case-control and cohort studies and an environmental survey.

RESULTS: Nine patients developed GNB with Enterobacter cloacae (6), Pseudomonas aeruginosa (5), Klebsiella pneumoniae (3), Serratia marcescens (2), or Klebsiella oxytoca (1) following OHS; five of nine patients had polymicrobial bacteremia.… Read more

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U.S. hospital mycobacteriology laboratories: status and comparison with state public health department laboratories

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Abstract

In response to the resurgence of tuberculosis, the Centers for Disease Control and Prevention recommended the use of certain mycobacteriology laboratory methods to improve the accuracy of diagnosis and/or minimize times to complete specimen processing. A study to determine the extent to which these recommended methods were being used in hospital laboratories was needed.… Read more

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The role of understaffing in central venous catheter-associated bloodstream infections

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Abstract

OBJECTIVE: To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.

DESIGN: Case-control and cohort studies of surgical intensive care unit (SICU) patients.

SETTING: A university-affiliated Veterans Affairs medical center.

PATIENTS: Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls.… Read more

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Ochrobactrum anthropi meningitis in pediatric pericardial allograft transplant recipients

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Abstract

An epidemiologic investigation was done after 3 patients contracted Ochrobactrum anthropi meningitis at one hospital in October 1994. Neurosurgical patients with pericardial tissue implants were at greater risk of infection than other neurosurgical patients (3/14 vs. 0/566; P… Read more

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Acremonium kiliense endophthalmitis that occurred after cataract extraction in an ambulatory surgical center and was traced to an environmental reservoir

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Abstract

During October and November 1993, four patients contracted Acremonium kiliense endophthalmitis at one ambulatory surgical center. We hypothesized that the source was environmental and conducted a matched case-control study, environmental evaluation, and observational studies. Case and control patients were similar in clinical characteristics.… Read more

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The epidemiology of colonization

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Abstract

Colonization is the presence of a microorganism in or on a host, with growth and multiplication but without any overt clinical expression or detected immune response in the host at the time it is isolated. Normal colonization in humans begins during the birth process and through subsequent contacts with the inanimate or animate environments until a delicately balanced “normal” flora is established; subsequently, the precise components of this flora evolve.… Read more

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Nosocomial transmission of Mycobacterium tuberculosis: role of health care workers in outbreak propagation

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Abstract

To investigate an outbreak of tuberculosis (TB) among health care workers (HCWs) at a county hospital, all patients with culture-confirmed TB on wards A and B and all HCWs working at least one shift on these wards from January 1991 through March 1992 were studied.… Read more

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Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections

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Abstract

Risk factors for vancomycin-resistant enterococcal (VRE) bloodstream infection (BSI) were studied at a tertiary-care hospital by comparing 46 patients with VRE-BSI with 46 randomly selected patients with vancomycin-susceptible enterococcal (VSE) BSI. Among patients with an enterococcal BSI, risk factors for mortality were determined.… Read more

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Tuberculosis infection-control practices in United States emergency departments

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Abstract

STUDY OBJECTIVE: To determine the frequency with which patients with suspected tuberculosis (TB) or TB risk factors present to US emergency departments and to describe current ED TB infection-control facilities and practices.

DESIGN: Mailed survey of a sample of EDs in US acute care facilities.… Read more

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Nosocomial outbreak of Candida albicans sternal wound infections following cardiac surgery traced to a scrub nurse

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Abstract

From August 1988 through October 1989, 15 patients at 1 hospital developed Candida albicans sternal wound infections after cardiac surgery. An investigation found that case-patients were more likely than cardiac surgery patients without sternal wound infections to have surgeries lasting 165 min (11/15 vs.… Read more

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Epidemic aluminum intoxication in hemodialysis patients traced to use of an aluminum pump

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Abstract

This study was designed to identify the source, risk factors, and clinical consequences of an outbreak of aluminum intoxication in hemodialysis patients using case-control and cohort studies. In 1991, a dialysis center in Pennsylvania [Dialysis Center A (DCA)] identified a number of patients with elevated serum aluminum levels.… Read more

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Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy

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Abstract

OBJECTIVE: To determine risk factors for bloodstream infections (BSIs) in an outbreak among patients receiving home intravenous infusion therapy.

DESIGN: Case-control and retrospective cohort studies.

SETTING: Home health agency.

PATIENTS: Patients receiving home intravenous infusion therapy from Rhode Island Home Therapeutics (RIHT) from January through December 1993.… Read more

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Magnetic phase diagram, static properties, and relaxation of the insulating spin glass CoCl2

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Abstract

DeFotis GC, Coffey GA, Cinquina CC, Chandarlapaty S, Brubaker WW, Krovich DJ, Chamberlain RV, Jarvis WR

Phys. Rev., B Condens. Matter 1995 Jun;51(21):15113-15124

PMID: 9978465… Read more

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Reducing the spread of antimicrobial-resistant microorganisms. Control of vancomycin-resistant enterococci

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Abstract

Strategies to reduce the spread of hospital-acquired microorganisms resistant to multiple antimicrobial agents are discussed. Because hospitals have experienced a rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (VRE) in the past 5 years, the Hospital Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention has issued recommendations for preventing the spread of vancomycin resistance.… Read more

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Epidemiology of nosocomial fungal infections, with emphasis on Candida species

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Abstract

Currently, about 180 hospitals participate in the National Nosocomial Infections Surveillance (NNIS) system. From January 1980 through April 1990, 27,200 fungal isolates causing nosocomial infections were reported from these hospitals; Candida species accounted for 19,621 (72.1%) of these isolates. Immunocompromised patients are at particularly high risk for candidemia.… Read more

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Tuberculosis in health care workers at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis

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Abstract

OBJECTIVE: Investigate reports of tuberculosis in health care workers employed at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis.

DESIGN: Case series of tuberculosis in health care workers, January 1, 1989, through May 31, 1992. Antimicrobial susceptibility testing and restriction fragment length polymorphism analysis of M tuberculosis isolates.… Read more

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An outbreak of pyrogenic reactions in chronic hemodialysis patients associated with hemodialyzer reuse

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Abstract

In February 1992, 22 patients undergoing chronic hemodialysis at an outpatient dialysis center experienced pyrogenic reactions (PR). The PR rate was significantly greater (p < 0.001) during the epidemic (February 3-5) than the pre-epidemic period (November 1, 1992-February 1, 1992). All patients with PR used dialyzers that had been manually reprocessed either on February 1 or 3. These dialyzers contained up to 120.8 EU/ml of endotoxin in the blood compartment. The only dialyzer reprocessed before February 1 that was available for analysis was found to contain no detectable endotoxin, while dialyzers reprocessed during the epidemic period contained a median endotoxin concentration of 52.8 EU/ml. The bioburden of water used to prepare dialysate was in excess of the Association for the Advancement of Medical Instrumentation (AAMI) standard for water, < or = 200 colony forming units (CFU)/ml. Samples of treated water collected in the reuse area were within AAMI standards at the time of the investigation (February 11 and February 26), but before the investigation, water samples were assayed with a culture method that could not detect microbial concentrations below 10(3) CFU/ml. In addition, the treated water feed line to the disinfectant container may never have been disinfected. However, no samples were collected from this line during the investigation. This outbreak emphasizes the need to use water that meets the AAMI bacteriologic and endotoxin standards of < or = to 200 CFU/ml and/or 5 EU/ml, respectively, for reprocessing hemodialyzers nad to ensure that appropriate culture techniques are used for treated water dialysate.

Rudnick JR, Arduino MJ, Bland LA, Cusick L, McAllister SK, Aguero SM, Jarvis WR

Artif Organs 1995 Apr;19(4):289-94

PMID: 7598647… Read more

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Epidemic nosocomial pneumonia in the intensive care unit

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Abstract

The changing and expanding spectrum of pathogens associated with nosocomial pneumonia (NP) will require modification in our approach to both endemic and epidemic NP in the ICU. Knowledge of specific pathogens, modes of transmission, and sources or reservoirs of epidemic NP is crucial to the recognition, control, and prevention of these infections in ICU patients.… Read more

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SHEA-CDC TB survey, Part II: Efficacy of TB infection control programs at member hospitals, 1992. Society for Healthcare Epidemiology of America

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Abstract

OBJECTIVE: To assess the efficacy of current Mycobacterium tuberculosis control measures.

DESIGN: Voluntary questionnaire to members of the Society for Healthcare Epidemiology of America.

RESULTS: Healthcare worker (HCW) tuberculin skin-test (TST) conversion rates were significantly higher in larger hospitals (or = 437 beds) (0.9% versus 0.6%; P < 0.05), or in hospitals reporting > or = 6 TB patients in 1992 (1.2% versus 0.6%; P < 0.05). Among larger hospitals or those hospitals surveyed reporting > or = 6 TB patients, those without at least three of the four criteria suggested in the 1990 Centers for Disease Control and Prevention (CDC) TB guidelines for acid-fast bacilli (AFB) isolation (specifically, a single-patient room; negative pressure; and air exhausted directly outside) had significantly higher annual TST conversion rates than those with these criteria (1.8% versus 0.6%; P < 0.05). Respiratory therapist or bronchoscopist TST conversion rates were significantly lower in hospitals compliant with the exhaust criteria (1.2% versus 2.8%; P < 0.05). Regardless of hospital characteristic, HCW TST conversion rates did not differ between hospitals in which HCWs used surgical masks or used disposable particulate respirators.

CONCLUSION: Among larger hospitals or hospitals reporting or = 6 TB patients per year, failure to comply with the 1990 CDC TB recommendations for AFB isolation room guidelines was associated with higher HCW TST conversion rates.… Read more

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SHEA-CDC TB survey, Part I: Status of TB infection control programs at member hospitals, 1989-1992. Society for Healthcare Epidemiology of America

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Abstract

OBJECTIVE: To determine trends in Mycobacterium tuberculosis infection in healthcare workers, tuberculosis (TB) control measures, and compliance with the 1990 Centers for Disease Control and Prevention (CDC) guideline for preventing transmission of TB in healthcare facilities.

DESIGN: Voluntary questionnaire sent to all members of the Society for Healthcare Epidemiology of America, representing 359 hospitals.… Read more

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Control of nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis among healthcare workers and HIV-infected patients

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Abstract

From 1988 to 1990, an outbreak of multidrug-resistant tuberculosis (MDR-TB) among patients, and an increased number of tuberculin-skin-test conversions among healthcare workers, occurred on the HIV ward of Jackson Memorial Hospital, Miami, Florida, USA. Measures similar to those subsequently recommended in the 1990 Centers for Disease Control and Prevention guidelines were implemented on the HIV ward by June, 1990, and in September, 1992, we evaluated the efficacy of these control measures.… Read more

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Efficacy of control measures in preventing nosocomial transmission of multidrug-resistant tuberculosis to patients and health care workers

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Abstract

OBJECTIVE: To assess the efficacy of control measures in decreasing nosocomial transmission of multidrug-resistant tuberculosis.

DESIGN: Retrospective cohort study.

SETTING: A teaching hospital in New York City.

POPULATION: 40 patients hospitalized with multidrug-resistant tuberculosis (case-patients) and health care workers receiving tuberculin skin testing.… Read more

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Respirators, recommendations, and regulations: the controversy surrounding protection of health care workers from tuberculosis

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Abstract

Recent nosocomial outbreaks of tuberculosis have increased concern about the occupational acquisition of tuberculosis by health care workers. The Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, and the Occupational Safety and Health Administration, Department of Labor, have issued recommendations and regulations in an effort to decrease health care workers’ risk for exposure to patients with infectious tuberculosis.… Read more

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An outbreak of gram-negative bloodstream infections in chronic hemodialysis patients

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Abstract

Six chronic hemodialysis patients acquired bloodstream infections (BSIs) with Klebsiella pneumoniae of the same serotype and similar plasmid profile during an 11-day period. The 6 case-patients were more likely than noncase-patients to have received dialysis during the fourth shift (p < 0.05) and to have their dialyzers reprocessed for reuse after those of the noncase-patients (p = 0.05). Investigation identified a patient during the same shift with an arteriovenous fistula infected with K. pneumoniae. The dialyzer reprocessing technician did not change gloves between contacting patients and their dialyzers in the treatment area and reprocessing the case-patients' dialyzers at the end of the fourth shift. We conclude that the outbreak of BSIs was caused by cross-contamination of the case-patients' dialyzers with bacteria from the gloves of the reprocessing technician and by inadequate dialyzer disinfection. After revised dialyzer reprocessing techniques and glove-changing policies were instituted, no further clusters of BSIs occurred.

Welbel SF, Schoendorf K, Bland LA, Arduino MJ, Groves C, Schable B, O’Hara CM, Tenover FC, Jarvis WR

Am.… Read more

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Latex sensitivity among perioperative nurses

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Abstract

To estimate the prevalence, risk factors, and clinical spectrum of adverse reactions to natural rubber latex-containing products among a national sample of perioperative nurses, the investigators administered a self-reporting questionnaire to a convenience sample of 2,200 members of the Association of Operating Room Nurses, Inc.… Read more

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Possible nosocomial transmission of Pseudomonas cepacia in patients with cystic fibrosis

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Abstract

OBJECTIVE: To determine whether nosocomial transmission of Pseudomonas cepacia occurred at a hospital with endemic P cepacia infection of patients with cystic fibrosis.

DESIGN: Two retrospective case-control studies.

SETTING: A large pediatric cystic fibrosis center.

PARTICIPANTS: To assess risk factors for acquisition of P cepacia, 18 cases, defined as any patient with cystic fibrosis with first documented isolation of P cepacia in 1988 or 1989, were compared with 18 matched P cepacia-negative controls with cystic fibrosis.… Read more

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Usefulness of molecular epidemiology for outbreak investigations

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Abstract

We conducted a retrospective review of nosocomial outbreak investigations conducted by the Hospital Infections Program, Centers for Disease Control and Prevention, from January 1991 through March 1994. Selected outbreaks have demonstrated the utility of molecular methods such as plasmid analysis, plasmid restriction endonuclease analysis, ribotyping, restriction fragment polymorphism, pulsed-field gel electrophoresis, and polymerase chain reaction in confirming the clonality of the outbreak and in confirming the source of the outbreak implicated in the epidemiologic investigation.… Read more

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Infectious diseases and death among nursing home residents: results of surveillance in 13 nursing homes

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Abstract

An increasing proportion of the U.S. population resides in nursing homes (NHs). No surveillance system exists for infections in these facilities. To determine the incidence and types of infections in NH residents, and to identify predictors of death among residents with infections, we initiated a surveillance system at 13 NHs in California during a 6-month period from October 1989 through March 1990.… Read more

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4-Methyl-7,11-heptadecadienal and 4-methyl-7,11-heptadecadienoic acid: new antibiotics from Sporothrix flocculosa and Sporothrix rugulosa

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Abstract

4-Methyl-7,11-heptadecadienal [1] and 4-methyl-7,11-heptadecadienoic acid [2] were isolated as new compounds from liquid cultures of Sporothrix flocculosa and Sporothrix rugulosa. Compounds 1 and 2 inhibited the growth of Fusarium oxysporum f. sp. lycospersici, Trichoderma viride, and Bacillus subtilis.

Choudhury SR, Traquair JA, Jarvis WR

J.… Read more

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Patient cytokine response in transfusion-associated sepsis

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Abstract

Cytokine concentrations in plasma from patients transfused with packed erythrocytes contaminated with gram-negative bacilli were measured. Cytokine concentrations in posttransfusion plasma were significantly elevated. A difference in cytokine patterns between survivors and a nonsurvivor was observed.

McAllister SK, Bland LA, Arduino MJ, Aguero SM, Wenger PN, Jarvis WR

Infect.… Read more

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Investigation of an epidemic of invasive aspergillosis: utility of molecular typing with the use of random amplified polymorphic DNA probes

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Abstract

When seven immunocompromised patients developed invasive aspergillosis during construction at a hospital, new methods were performed to compare fungal isolates and a case-control study was conducted to determine risks for infection. Typing of Aspergillus flavus with the use of restriction endonuclease analysis and restriction fragment length polymorphism using random amplified polymorphic DNA reactions to generate DNA probes revealed different patterns between isolates from two patients and a similar pattern among those from one patient, a health care worker, and an environmental source.… Read more

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Acquisition of Pseudomonas cepacia at summer camps for patients with cystic fibrosis. Summer Camp Study Group

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Abstract

To assess the risk of acquisition of Pseudomonas cepacia by person-to-person transmission at cystic fibrosis summer camps, we conducted in 1990 a study at three camps attended by patients with cystic fibrosis who had P. cepacia infection and patients without P.… Read more

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Epidemic Clostridium difficile-associated diarrhea: role of second- and third-generation cephalosporins

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Abstract

OBJECTIVE: To better define the role of multiple risk factors for cytotoxic Clostridium difficile-associated diarrhea.

DESIGN: Case-control study.

SETTING: A Veterans Affairs Medical Center.

PATIENTS: Thirty-three case patients with C difficile-associated diarrhea. Two control groups were used: one group consisted of 32 patients from the same ward as the case patients, and one group consisted of 34 patients with nosocomial diarrhea and negative C difficile toxin assays.… Read more

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Bacterial contamination of platelets at a university hospital: increased identification due to intensified surveillance

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Abstract

BACKGROUND: A cluster of bacterial contamination of platelets occurred at a university hospital in a one-month period. This unusual clustering allowed us to examine the likely mechanism of contamination and clinical sequelae.

METHODS: We reviewed medical records of patients receiving random donor platelet transfusions to determine numbers of platelets transfused, reactions reported, and episodes of bacterial contamination.… Read more

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Nosocomial Malassezia pachydermatis bloodstream infections in a neonatal intensive care unit

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Abstract

Malassezia pachydermatis, a lipophilic yeast, has been described to cause sporadic nosocomial bloodstream infections (BSI). Nosocomial outbreaks of M. pachydermatis BSI have never been described. A cluster of M. pachydermatis BSIs in the neonatal intensive care unit at Louisiana State University Medical Center, University Hospital provided the opportunity to investigate the epidemiology of this organism and apply molecular epidemiologic typing techniques.… Read more

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How common is latex allergy? A survey of children with myelodysplasia

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Abstract

To estimate the prevalence of latex allergy among children with myelodysplasia, describe the spectrum of associated clinical symptoms and evaluate potential risk factors for the development of latex sensitization, the authors conducted a survey at a regional spina bifida center.… Read more

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Outbreak of pyrogenic reactions and gram-negative bacteremia in a hemodialysis center

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Abstract

Six episodes of gram-negative bacteremia and seven pyrogenic reactions occurred in 11 patients in one hemodialysis center. Gram-negative bacteremias and/or pyrogenic reactions were not related to reuse and were more likely to occur if dialysis was performed in one unit of the center (8/13 unit 5 vs.… Read more

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Infectious diseases and mortality among US nursing home residents

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Abstract

Data collected in the 1985 National Nursing Home Survey were analyzed to identify risk factors for infections and mortality and to explore their relationship in US nursing homes. An infection was recorded in 166,609 (14%) discharges. Risk of pneumonia was found to be higher among bedbound patients (54.5 vs 13.1 per 100 discharges); urinary tract and other infections were most frequent among residents with indwelling catheters (6.6 vs 1.0 per 100 discharges).… Read more

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Cluster of Enterobacter cloacae pseudobacteremias associated with use of an agar slant blood culturing system

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Abstract

From 1 February through 12 October 1990, 27 blood cultures processed at Shiprock Hospital were positive for Enterobacter cloacae; only 3 had been reported in the preceding 12 months. Twenty (74%) of the cultures were obtained from patients without clinical evidence of gram-negative septicemia.… Read more

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Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. National Nosocomial Infections Surveillance System

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Abstract

To identify pathogens causing nosocomial fungal infections and the secular trend in their incidence in US hospitals, data from the National Nosocomial Infections Surveillance System, 1980-1990, were analyzed. During that period, 30,477 fungal infections were reported. The rate rose from 2.0 to 3.8 infections/1000 discharges.… Read more

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Outbreak of Pseudomonas cepacia bacteremia in oncology patients

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Abstract

In 1991, an outbreak of Pseudomonas cepacia bacteremia (PCB) occurred among patients at an oncology clinic in Alabama. A case-patient was defined as any patient at Alabama Oncology Hematology Associates (AOHA) who had at least one blood culture positive for P.… Read more

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Nosocomial infections in surgical patients in the United States, January 1986-June 1992. National Nosocomial Infections Surveillance (NNIS) System

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Abstract

OBJECTIVES: To describe the distribution of nosocomial infections among surgical patients by site of infection for different types of operations, and to show how the risk of certain adverse outcomes associated with nosocomial infection varied by site, type of operation, and exposure to specific medical devices.… Read more